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Case 95

Pulmonary metastasis from osteosarcoma, pneumothorax

Findings

Chest X-ray - Right pneumothorax

Tibia & Fibula X-ray - Lytic lesion with areas of osteod matrix in midportion of right tibia with a motheaten appearance of adjacent trabeculae, a sunburst type of periostal reaction, soft tissue involvement and evidence of a well defined sclerotic lesion in the distal end.

Diagnosis

Spontaneous pnuemothorax due to pulmonary metastasis from osteosarcoma

Discussion

Regarding Osteogenic Sarcoma:

1. Occurs in the age group 10-25 years mainly in the distal femur, proximal tibia, proximal humerus and pelvis
2. Appearances
   • Metaphyseal
   • May be predominantly lytic, sclerotic or mixed
   • Wide zone of transition with normal bone
   • Cortical destruction with soft-tissue extension
   • +/- internal calcification of bone
   • Periostal reaction - 'sunray' spiculation, lamellated and/or Codman's triangle
3. Spontaneous pneumothorax
   • An unusual but recognised complication of lung metastasis. Metastasis from sarcoma, mainly osteogenic, is the common cause. A contributory role of chemotherapy to cause pneumothorax has been suggested

References

Grainger and Allison's Diagnostic Radiology. Vol 1, p 254

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